Abstract
Purpose
For over 150 years of anesthetic practice, it was believed that the effects of general
anesthetics were temporary and not adverse. A growing number of studies over the past
2 decades, however, have identified structural and cognitive abnormalities, especially
in the developing brain. Despite the growing evidence of anesthetic-induced neurotoxicity
in animal studies, the evidence to date in humans has been inconsistent and unclear.
Sevoflurane, a commonly used inhalational agent in pediatric anesthesia, is an agent
of choice for inhalational induction due to its rapid activity and low blood-gas solubility.
With evaluation of the current literature, improved considerations can be made regarding
the widespread use of sevoflurane as an anesthetic.
Methods
PubMed database was searched for article published between 1969 through 2020. The
reference lists of identified articles were searched manually for additional papers
eligible for inclusion. This review addressed the tolerability of sevoflurane in specific
populations, particularly pediatrics, and is divided into 3 parts: (1) the history
of sevoflurane use in anesthetic practice and the pharmacokinetic properties that
make it advantageous in pediatric populations; (2) proposed mechanisms of anesthesia-induced
neurotoxicity; and (3) considerations due to potential adverse effects of sevoflurane
in both short and long procedures.
Findings
There is reason for concern regarding the neurotoxic effects of sevoflurane in both
the pediatric and elderly populations, as spatial memory loss, developmental deficits,
and an enhanced risk for Alzheimer disease have been linked with the use of this popular
inhalational agent.
Implications
The duration and dose of sevoflurane may need to be altered, especially in longer
procedures in pediatric populations. This may change how sevoflurane is administered,
thus indicating a greater demand for an understanding of its limitations as an anesthetic
agent.
Key words
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Article info
Publication history
Published online: March 02, 2021
Accepted:
January 25,
2021
Identification
Copyright
© 2021 Elsevier Inc.
